关节腔注射透明质酸与物理疗法治疗颞下颌关节不可复性盘前移位的临床疗效对比

Comparison of the effectiveness of intra-articular injection of hyaluronic acid and physical therapy for temporomandibular joint anterior disc displacement without reduction

目的比较关节腔注射透明质酸和物理疗法治疗颞下颌关节不可复性盘前移(anterior disc displacement without reduction,ADDwoR)的临床疗效。方法回顾性纳入2018年2月—2020年8月于我院康复科门诊就诊的ADDwoR患者72例,注射组和物理治疗组各36例。比较治疗前、治疗中和治疗结束后的症状和功能情况,包括最大主动开口度(maximum active mouth opening,MMO)、视觉模拟疼痛指数评估(visual analogue pain score,VAS)(0~10分)、下颌功能限制评估量表(jaw functional limitation scale,JFLS)和有效性。应用统计软件SPSS 26.0进行数据分析,采用卡方χ2检验、t检验和单变量方差分析,以P<0.05为差异有统计学意义。结果与本组治疗前比较,两种治疗方法在治疗中、治疗后所有指标均有统计学差异(P<0.05)。组间比较,两种方法在治疗中、治疗后的MMO差异均有统计学意义(F=11.160,P<0.05;F=6.766,P<0.05)。与注射组相比,物理治疗组在治疗中和治疗后MMO分别多2.5 mm(95%CI:1.1~4.0,P=0.001)、3.1 mm(95%CI:1.0~5.3,P=0.005)。注射组治疗有效25例(69.4%),物理治疗组有效27例(75.0%),组间无统计学差异(χ^(2)=0.277,P>0.05)。结论物理疗法和关节腔注射透明质酸都可以减轻ADDwoR患者的疼痛,增加MMO,并改善下颌功能,物理疗法对开口度的治疗效果更好。

Objective To compare the effectiveness of intra-articular injection of hyaluronic acid(HA)and physical therapy for temporomandibular joint anterior disc displacement without reduction(ADDwoR).Methods A total of 72 patients with ADDwoR who completed the treatment in the authors’department from February 2018 to August 2020 were included.Thirty-six patients received intra-articular injection of HA,and 36 patients received individualized comprehensive physiotherapy.Outcome assessment measures were maximum active mouth opening(MMO),visual analogue pain score(VAS)(0-10),jaw functional limitation scale(JFLS)and effective rate before,during and after treatment.SPSS 26.0 software package was used for data analysis of chi square test,t test and univariate analysis of variance.The difference was statistically significant in P<0.05.Results Compared with before treatment,there were significant differences in MMO,VAS and JFLS during and after treatment in the two groups(P<0.05).There were significant differences in MMO between the two groups during and after treatment(F=11.160,P<0.05;F=6.766,P<0.05).Compared with the injection group,the MMO of physical therapy group increased during and after treatment by 2.5 mm(95%CI:1.1-4.0,P=0.001)and 3.1 mm(95%CI:1.0-5.3,P=0.005).Twenty-five cases(69.4%)were effective in the injection group,and 27 cases(75.0%)were effective in the physical therapy group.There was no significant difference in the effective rate between the two groups(χ^(2)=0.277,P>0.05).Conclusion Both physical therapy and intra-articular injection of HA can reduce the pain,increase the maximum active mouth opening and improve the mandibular function of ADDwoR patients.Physical therapy has a better effect on MMO.